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PubMed2000

Hock lesions and free-stall design.

We compared the prevalence and severity of skin lesions on the hocks of lactating dairy cows in southern British Columbia, comparing 20 farms using three common bedding surfaces: sawdust, sand, and geotextile mattresses. Skin lesions were scored at five positions on the hock. For each position we noted if the lesion showed inflammatory attributes, and then assigned a severity score. Of the 1752 lactating cows scored, 1267 cows (73%) had at least one hock lesion. Of those cows with lesions, 87% had lesions on both legs, 76% had lesions on more than one location on the hock, and 78% had a lesion of at least moderate severity (i.e., evidence of skin breakage or an area of hair loss >10 cm2). Lesions were most prevalent on farms that used geotextile mattresses (91% of cows) and least common on farms that used sand (24% of cows). Moreover, lesions on cows from farms using mattresses were more numerous and more severe than those on cows from sand-bedded farms. The prevalence and severity of lesions on farms using sawdust was intermediate. Lesions also varied in relation to location on the hock. For farms using geotextile mattresses, lesions were more common and more severe on the lateral surfaces of both the tuber calcis and the tarsal joint. On farms using sawdust, lesions were common on the dorsal surface of the tuber calcis and the lateral surfaces of both the tuber calcis and the tarsal joint. Lesions were rare on all five positions for cows from sand-bedded farms. Among the 10 farms sampled using sawdust, we found a significant negative relationship between the length of the stall and severity of lesions. For cows with lesions, the number and severity of lesions increased with age.

Animals↗

PubMed2003

Effects of three types of free-stall surfaces on preferences and stall usage by dairy cows.

One important criterion in choosing appropriate housing systems for dairy cattle is that the freestall provides a comfortable surface for the cow. This paper describes two experiments testing the effects of commonly used lying surfaces on stall preference and stall usage by Holstein cows. In both experiments, 12 cows were housed individually in separate pens. Each pen contained three free stalls with a different surface: deep-bedded sawdust, deep-bedded sand, and a geotextile mattress covered with 2 to 3 cm of sawdust. The animals were restricted to each surface in turn, in a random order for either 2 (Experiment 1) or 3 d (Experiment 2). Both before and after this restriction phase, the animals were allowed access to all three surfaces, and preference was determined, based on lying times. Of the 12 cows used in Experiment 1, 10 preferred sawdust before and nine after the restriction phase. During the restriction phase, average lying times and number of lying events during the restriction phase were significantly lower for the sand-bedded stalls (P < or = 0.05), and standing times were higher on mattresses (P < or = 0.05), compared with sawdust. Although these cows had some experience with all three surfaces during the experiment, they had been housed in sawdust-bedded stalls during their previous lactation. Cows used in Experiment 2 had spent their previous lactation in sand bedded stalls. In this experiment, about half the cows preferred sand and half sawdust, after the restriction phase. During the restriction phase of experiment, lying times and number of lying events were lower, and standing times were higher when the animals were restricted to the mattresses compared to either sand or sawdust (P < or = 0.05). These results indicate that (1) free stall surface can affect both stall preferences and stall usage, and (2) mattresses are less preferred.

Animals↗

PubMed1999

Comparison of anastomotic suturing techniques in the rat esophagus.

BACKGROUND: Long-gap esophageal atresia continues to be a challenging pediatric thoracic surgical problem. Despite the use of various tension relieving procedures, the esophageal anastomosis is often performed under considerable tension. Excessive tension can cause anastomotic sutures to pull through the esophageal tissue, with resultant early esophageal anastomotic dehiscence. To test the hypothesis that interrupted horizontal mattress sutures would withstand the forces of tension better than interrupted simple sutures, an experimental study of rat esophageal anastomoses was done. METHODS: Twenty rats were killed and their esophagi were excised. The esophagi were divided in the mid portion and end-to-end anastomoses were done using interrupted 6-0 polypropylene sutures. Ten rats had anastomoses done with interrupted simple sutures and ten had interrupted horizontal mattress suturing. Anastomotic breaking strength was tested in a tensiometer. RESULTS: Anastomotic breaking strength was 3.22+/-0.56 N for the interrupted simple sutured anastomoses and 3.51+/-0.61 N for the interrupted horizontal mattress group (p=0.30). The difference was not significant. CONCLUSIONS: In this animal study interrupted simple and horizontal mattress suturing withstood the disruptive forces of anastomotic tension equally well.

Anastomosis, Surgical↗

PubMed2000

Comparison of the effectiveness of two pressure-relieving surfaces: low-air-loss versus static fluid.

Limited research has been done to determine the effectiveness of the multitude of pressure reduction devices currently available for patient care. The purpose of this investigation was to examine the relative effectiveness of a dynamic low-air-loss (LAL) mattress and a static fluid mattress in reducing the risk of pressure ulcer development. The investigation consisted of two components: a comparative laboratory study and a retrospective clinical study. In the laboratory study, tissue interface pressures were measured on the two surfaces at three interface sites in a sample of six healthy adult volunteers. In the clinical study, a retrospective chart review was conducted to compare the actual incidence of pressure ulcer formation in a sample of 73 postoperative transplant patients who were placed on either the static fluid or LAL product. The instruments used were the Xsensor Pressure Mapping System (laboratory) and chart review tool (clinical). The main outcome measures included tissue interface pressures and incidence of pressure ulcer formation. The results were as follows: the laboratory study revealed significantly lower sacral pressures (t = -5.30, P = .003) on the low-air-loss mattress than on the static fluid mattress. Pressures did not differ significantly at the heel or trochanter sites. In the clinical study, the overall incidence of skin breakdown was 8.2%, with 5 occurrences (13.8%) in the LAL group and 1 occurrence (2.7%) in the static fluid group. However, this difference was not significant (Fisher's exact test = 0.107, P = .09). When considered jointly, the results of the two studies suggest that the static fluid and LAL products may be comparable in efficacy. Although the relatively small sample sizes used in the investigation limit generalizability, the results provide some initial direction for further clinical research in this area.

Adult↗

PubMed2001

[Less frequent turning intervals and yet less pressure ulcers].

The aim of the doctoral dissertation summarised here, was to study the effect of different turning intervals and to optimise this method of pressure ulcer prevention. Prior to the main study, the pressure reducing effect of mattresses, cushions, sitting and lying positions was investigated. Based on the results of 3 pre-studies, 4 different turning schemes were compared in a randomised controlled trial in 838 high-risk nursing home residents. Turning every 4 hours in combination with the use of a pressure reducing viscoelastic mattress reduced the number of pressure ulcers significantly compared to the other 3 schemes: turning every 6 hours on a viscoelastic mattress, and turning every 2 or 4 hours on a non-pressure reducing mattress.

Aged↗

PubMed2002

A modified infarct exclusion technique for a post-infarction ventricular septal defect.

BACKGROUND: Operative mortality for a post-infarction ventricular septal defect (VSD) remains high. The infarct exclusion technique has been producing a favorable outcome for repairing this serious defect. However, there is the technical weakness, namely running suture along the base of the necrotic septum. We sutured a pericardial patch using multiple interrupted mattress sutures in such a manner as to exclude the infarct and VSD. METHODS: Over the past seven years, nine consecutive patients with a post-infarction VSD underwent an early repair in the same manner. The VSD was anterior in eight patients and posterior in one. We sutured a xenopericardial patch to the healthy myocardium around the infarct using interrupted mattress sutures instead of running sutures as the infarct exclusion technique. In addition, on the postero-inferior margin of the patch, one or two mattress sutures passing through the full thickness of the anterior papillary muscle were used. RESULTS: Only one patient died of pneumonia 50 days after surgery. The other eight patients were followed up and were functionally classified as NYHA class I or II. CONCLUSIONS: These findings suggest that our modified infarct exclusion technique using multiple mattress sutures is an effective alternative surgical technique.

Aged↗

PubMed2003

[Sutures in skin surgery].

Dermatologists performing skin surgery mostly use the square knot. Other underused or even forgotten suturing techniques may still be helpful in some instances. We shall emphasize some simple techniques such as the horizontal mattress suture, the "cross stitch", the "corner stitch" (half buried mattress suture), the buried dermal suture, the buried vertical mattress suture, the continuous mattress suture and the running intradermal suture. In given circumstances, all of them may improve suturing and promote healing. Technical aspects, advantages and disadvantages of each type of suture will be briefly described.

Dermatologic Surgical Procedures↗

PubMed2003

[The efficacy of carbon-fiber resistive-heating in prevention of core hypothermia during major abdominal surgery].

BACKGROUND: Perioperative hypothermia causes numerous severe complications, such as coagulopathy, surgical wound infections, and morbid myocardial outcomes. For prevention of intraoperative hypothermia, an inexpensive, non-disposable carbon fiber resistive warming system has been developed. METHODS: We evaluated the efficacy of resistive-heating, comparing to circulating-water mattress and forced-air warming system. Twenty four patients undergoing elective abdominal surgery were randomly assigned to warming with: 1) a circulating water mattress, 2) a lower-body forced-air system, or 3) a carbon-fiber, resistive-heating blanket. RESULTS: Tympanic membrane temperature in the first two hours of surgery decreased by 1.9 +/- 0.5 degrees C in the water mattress group, 1.0 +/- 0.6 degree C in the forced-air group, 0.8 +/- 0.2 degree C in the resistive-heating group. The decreases in core temperature by the end of surgery were 2.0 +/- 0.8 degrees C in the water mattress group, 0.6 +/- 1.1 degrees C in the forced-air group, and 0.5 +/- 0.4 degree C in the resistive blanket group, respectively. There was no significant difference in the changes of core temperature between the forced-air group and the resistive-heating group. No side effects related to resistive-heating blanket were observed. CONCLUSIONS: Even during major abdominal surgery, carbon-fiber resistive-heating maintains core temperature as effectively as forced air.

Abdomen↗

PubMed1976

[The biology of the house dust mite Dermatophagoides pteronyssinus (Trouessart, 1897) (acarina:astigmata). I. Colonization of mites on new matresses].

The prevalence of the house-dust mite Dermatophagoides pteronyssinus in four different kinds of test mattresses was investigated. In a first series of experiments the mites showed no preference to any of the mattresses - irrespective of the stuffing material - when the surface was smooth and unstitched. In a second series of experiments two buttons each were sewed on on both sides of the mattresses. Subsequently the mites showed a distinct preference to the depressed area around the buttons. These findings were confirmed in used mattresses provided by patients. The importance of these "nishes" in relation to mite allergies is discussed.

Bedding and Linens↗

PubMed2004

The efficacy of benzyl benzoate sprays in killing the storage mite Tyrophagus putrescentiae (Acari: Acaridae).

This study tested the effectiveness of benzyl benzoate (BB) in killing Tyrophagus putrescentiae (Schrank) mites when using the method utilized by regular consumers. The efficacy of the BB sprays was determined in laboratory experiments and semi-field experiments with mattress and mattress pad pieces. The mites were counted and their living status determined at different time points microscopically. In the laboratory experiment, the sprays containing either 0.5 %/0.9 % BB with 70 % ethanol or 0.1 % BB with absolute ethanol were highly efficient, resulting in over 90 % mite mortality within 20-30 minutes. In the semi-field experiment, mimicking the home application, the sprays were applied to pieces of a mattress and a mattress pad, and allowed to affect the area for 30 minutes before thorough vacuuming. The recovery of mites was usually less than 10 %. The sprays containing BB were effective in killing the mites in the laboratory, but success was less prominent in the semi-field tests. This method could be used in testing other compounds for their efficacy in killing mites.

Acaridae↗

PubMed1992

Tissue interface pressure and estimated subcutaneous pressures of 11 different pressure-reducing support surfaces.

This pilot study examined the pressure-reducing properties of 11 different pressure-reducing devices as compared to a standard hospital mattress. Mean trochanteric and heel pressure readings were obtained on each surface from 13 healthy adult volunteers by using an electropneumatic pressure transducer (Gaymar, catalog # PSM1). Mean trochanteric pressures ranged from 37.2 mm Hg to 55.1 mm Hg on the pressure-reducing support surfaces as compared to 83.6 mm Hg on a standard hospital mattress. Mean heel pressure readings ranged from 28.1 mm Hg to 62.1 mm Hg on the pressure-reducing support surfaces as compared to 93.9 mm Hg on the standard hospital mattress. While pressure-reducing support surfaces were found to yield significantly lower mean pressure readings than the standard hospital mattress, none of them is capable of preventing tissue ischemia if the subcutaneous pressure is three to five times higher than the interface pressure.

Adult↗

PubMed1992

A clinical comparison of two pressure-reducing surfaces in the management of pressure ulcers.

The purpose of this study was to compare the clinical outcomes of pressure ulcers treated on a low-air loss bed and a foam mattress with loose-fitting top cover. The two-group, non-randomized study design consisted of a convenience sample of 20 subjects: 10 subjects treated on the low-air loss bed and 10 subjects treated on the foam mattress with loose-fitting top cover. Subjects were selected from among patients located in the medical/surgical, critical care, and the skilled nursing units of a metropolitan public teaching hospital. Descriptive data, laboratory data, pressure ulcer transparency drawing, and pressure ulcer photographs were obtained on each subject every seven days from two to four weeks. A one-way analysis of variance indicated that there was no statistically significant difference in the pressure ulcer outcomes of subjects treated on the low-air loss bed (Mediscus) compared to the pressure ulcer outcomes of subjects treated on the foam mattress with loose-fitting top cover (Comfortex). Analysis of covariance further indicated no statistically significant difference in the pressure ulcer outcome of subjects treated on either pressure-relieving surface according to the subjects': a) age, percent ideal body weight, presence of pressure ulcer infection; b) leukocyte count, total lymphocyte count, and albumin level; and c) level of sensory perception, moisture, activity, mobility, nutrition, friction, and shear. Results from this study indicate that the low-air loss bed and foam mattress with loose-fitting top cover provide comparable pressure ulcer outcomes. Implications for nursing and recommendations for further study are included in the text.

Air↗

PubMedDate not supplied

Annual fluctuations of mites and fungi in Danish house-dust: an example.

For one year dust was sampled monthly from a single mattress. Until August mite counts were at background levels. In September and October there was a burst in the counts for the house-dust mite, Dermatophagoides farinae and for the house mite, Glycyphagus domesticus. Their occurrence might be interpreted as a response to large densities of an unidentified yeast in September. This yeast appeared when the indoor absolute humidity exceeded 9 g H2O/kg dry air. The mite Tarsonemus rakowiensis reached its maximum in October, and might be a possible house-dust mite predator, although the evidence is far from conclusive. An aliquot of ten grams of mattress dust sampled from a mite-free location on top of the mattress hardly became infested, although the environmental conditions were ideal. Obviously, the mattress dust from the dry room was not optimal for either the yeast or the mites.

Animals↗

PubMed1993

In vivo (CT scan) comparison of vertical shear in human tissue caused by various support surfaces.

Shear stress and shear strain of human tissue were calculated in vivo using measurements derived from pelvic CT scans of three subjects lying upon three depths of foam mattress overlays and an air mattress overlay commonly used in the prevention of pressure ulcers. The air mattress overlay plus three-inch foam had the lowest degree of tissue shear when compared with the foam overlays both quantitatively and qualitatively. In addition, it was found that the contouring air mattress overlay plus three-inch foam provided the greatest area of contact between surface support and subject when compared to the foam overlays, resulting in a greater distribution of applied load and ultimately decreasing tissue shear.

Adult↗

PubMed1993

A randomized trial of low-air-loss beds for treatment of pressure ulcers.

OBJECTIVE: To assess the effectiveness of low-air-loss beds for the treatment of pressure ulcers in nursing homes. DESIGN: Prospective, randomized, clinical trial. SETTING: Three teaching nursing homes in Los Angeles, Calif. SUBJECTS: Eighty-four nursing home residents with trunk or trochanter pressure ulcers (Shea stage > or = 2). INTERVENTIONS: Subjects were randomly assigned to use either a low-air-loss bed (n = 43) or a 10-cm corrugated foam mattress (n = 41) throughout the healing of their ulcers. OUTCOME MEASURES: Ulcers were assessed twice weekly using surface area and two observational scales (median follow-up, 37.5 days; range, 4 to 571 days). RESULTS: Groups were similar with respect to demographics, medical variables, wound care, and early dropouts. Results indicate more than a threefold improvement in median rate of healing for low-air-loss beds compared with foam mattresses (9.0 vs 2.5 mm2/d; P = .0002). This finding was true for deep as well as superficial ulcers (deep ulcers, 9.9 vs 0.7 mm2/d; P = .02; superficial ulcers, 9.0 vs 3.2 mm2/d; P = .004). Cox regression models revealed that the bed, ulcer depth, and fecal continence had independent effects on healing. After controlling for fecal continence, the deep and superficial subgroups using low-air-loss beds remained 2.5 times more likely to heal in a given length of time compared with those using foam mattresses (combined cure probability ratio, 2.66; 95% confidence interval, 1.34 to 5.17; P < .004). CONCLUSION: Low-air-loss beds provide substantial improvement compared with foam mattresses despite other factors in pressure ulcer healing.

Aged↗

PubMed1995

The effects of waterbeds on heart rate in preterm infants.

The purpose of this study was to investigate the effects of waterbeds on heart rate (HR) in preterm infants. Subjects were 22 medically stable preterm infants. Across a 10-day study, HR was determined for a 1-hour period on each day. Baseline HRs with infants on the standard incubator mattress were obtained on the first 2 days of the study. They were then placed on the waterbed for 4 days. They were then returned to the incubator mattress and studied for 4 more days. Infants served as their own controls among baseline, on-waterbed (On-WB) and off-waterbed (Off-WB) periods. HR was determined by using a heart beat counting feature of the neonatal cardio-respiratory monitors. Analysis of variance revealed significant HR variability among subjects. There was no difference between baseline HR and on-waterbed HR. The HR increased when infants were transferred back to the standard mattress. The possibility that theophylline acted as a confound existed because doses were changed and levels varied for some subjects within the study period. Eight infants responded to the waterbed with lower HR during the On-WB period compared to the baseline (mean reduction = 5.7 bpm). The findings that HRs rose when the infants were returned to the incubator mattress are similar to those of a previous study. The subjects' reactivity to changes in treatment condition continues to confound the question as to whether waterbed therapy effects a reduction in HR. Since waterbeds have consistently resulted in soothing effects such as improved sleep and lowered activity, failure to produce a concomitant reduction in HR warrants attention toward other factors that may be determinants of heart rate. The high variability within and among subjects raises questions as to the usefulness of the HR variable for determining energy costs.

Analysis of Variance↗

PubMedDate not supplied

Mite sensitivity and exposure in the city of Santa Fe, Argentina.

Little information is available on mite allergen levels and rates of sensitization to domestic mites in South America. The purpose of this study was to establish the rate of sensitization to domestic mites in asthmatics and measure mite allergen levels in pillows and mattresses of mite allergic individuals in Santa Fe, Argentina. Dust samples were collected from the pillows and mattresses of 56 asthmatics (24 females and 32 males, mean age 17.6 +/- 11.5 years), who had been previously skin tested with standardized extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae and (1:50 w/v) extracts of Aleuroglyphus ovatus, Blomia tropicalis, Chortoglyphus arcuatus. A wheal > or = 3 mm was considered positive. Sensitization to Lepidoglyphus destructor and Euroglyphus maynei was determined by RAST and considered positive when a serum bound > or = 1% of the total counts added. Forty six individuals had a positive skin test to D. pteronyssinus, 43 to D. farinae, 27 to A. ovatus, 38 to B. tropicalis, 27 to C. arcuatus; 38 of 54 individuals had a positive RAST to E. maynei and 22 of 54 to L. destructor. The mean Group 1 (Der p 1 + Derf 1) level in pillows (n = 48) was 6.7 micrograms/g (1-55.4) and in mattresses (n = 52) 4.3 micrograms/g (1-38.8). There is a high degree of sensitization to domestic mites among asthmatics in Santa Fe. High mite allergen levels (> 2 micrograms/g) can be detected very often in pillows and mattresses.

Adolescent↗

PubMed1996

[Effects of soft bedding on body perception and posture].

This investigation in several hospitals of the Federal Republic of Germany attempts for the first time to demonstrate the effects of soft bedding on the patients' condition on hand of well known and in other disciplines well established criteria. It could be shown that the softness of the mattress causes considerable problems for the patient. Furthermore, it becomes clear that the extent of nursing increases markedly with a very soft bedding of the patient in order to compensate for the disadvantages arising from it. Materials used in the prevention of bed sores (so called antidecubitus mattresses) have to be evaluated critically. Nurses must attempt to determine which kind of mattress ought to be used. If the mobility of the patient is not to be restricted even more, the use of a harder mattress may have to be considered.

Activities of Daily Living↗